Health and Well-Being Matter is the monthly blog of the Director of the Office of Disease Prevention and Health Promotion.
Equity ensures individuals have the fullest and fairest opportunities and conditions to thrive. In the simplest of terms, equity allows for resource allocation based on and commensurate to need, regardless of circumstance.
Today, our nation is realizing that equity is imperative to public health. Health equity is a necessary condition in the pursuit of meaningful health outcomes for individuals and society. The health of communities, and the nation, is unattainable without equitable access to the conditions that favor health and the ability to propitiously influence those conditions – what some refer to as civic muscle. Now, more than ever, we are aware of the importance of community-defined needs and community-driven action to improve health and well-being.
There is, however, a great deal of inherent inertia toward systems-level change that continues to inhibit equitable approaches to public health. Much of that stems from a historical approach to public health focused on reaction and response to health threats that limits and misdirects our public health systems and investments.
Forward-looking, coordinated investments in public health – specifically those that advance health-promoting and preventive strategies as the basis for a broad, sustained approach – have historically been under-resourced and under-utilized, if not disregarded altogether. This has certainly been true in the prevention of chronic diseases, as evidenced by increasing rates of obesity, diabetes, mental illness, substance use disorders, and uncontrolled hypertension. But it has also been true overall in addressing and improving the social determinants of health – the conditions in the environments where people are born, live, learn, work, play, worship, and age – that affect a wide range of health, functioning, and quality of life outcomes and risks.
We know now that neglect in both these areas foreshadowed the direst outcomes for COVID-19. When the pandemic began affecting all our lives, our familiar focus on the treatment of disease – rather than its prevention or the bolstering of resilience in people and communities – became even more evident. If we take no other lesson away from the pandemic, it should be this: the value proposition for being healthy; for being mentally, physically, and socially well; for enhanced resilience; and for pursuing these things equitably is paramount. Going forward, it would be irresponsible to accept our nation continuing to fail to account for arrant disparities and not striving to be more resilient than we were in 2019.
The last 2 years have underscored what we've observed, if not actually addressed, for some time: that when it comes to our health and well-being, the cost of indifference adds tremendously to risk. We continue to see poorer outcomes in those with largely preventable, chronic conditions. We also see poorer outcomes for those who routinely suffer inequities in the social determinants of health or vital conditions for health and well-being. Certainly, we have come to realize that when one segment of our community is at risk, we are all at risk.
Although many public health professionals are likely experiencing pandemic fatigue and hoping – along with the rest of the nation – that the end to the pandemic is nearing, we have more work to do. Despite the exhaustion, there is an opportunity before us that we should take advantage of.
In this current state of increased – and even critical – attention to what public health is and should be, the opportunity exists to make the necessary systemic changes to better marshal and focus resources where they are needed and to affect meaningful change to inequities. We can potentially not only recover from the pandemic but also from the inequity that has gone unaddressed for far too long. We can realize the ideal of public health that we’ve aspired to, where all sectors of society play a role in ensuring well-being – and we can make a lasting contribution to the vision of all people and places thriving without exception.
Since ODPHP’s inception in 1976, working toward this end has been central to our office’s mission. It has also been at the heart of the Healthy People initiative, the nation’s 10-year plan for addressing our most critical public health priorities and challenges.
Both ODPHP and Healthy People have evolved over the decades, increasing the focus on equity and strengthening commitments and actions supporting it. Notably, Healthy People 2030 includes a variety of resources to help individuals, organizations, and communities support the elimination of health disparities and advance health equity.
We recently released an environmental scan on how health equity and health disparities are defined and communicated within the field of public health. Of particular interest to us, we learned how a diverse cross section of those working in the field of public health defined terms such as equity and disparity and the various frameworks they were using to communicate about these topics. This material will help inform the development and dissemination of health equity and health disparities content and new products for Healthy People 2030, expanding the reach of our equity efforts. I encourage you to visit the new Health Equity in Healthy People 2030 webpage for more details – and to check back often for new resources.
I also urge you to be on the lookout for the imminent release of the Federal Plan for Equitable Long-Term Recovery and Resilience (ELTRR). Primarily a road map for federal partners, but intended to be harmonizing with civil society, the Plan informs how a whole-of-government approach to the issue of equitable long-term recovery will be implemented with a sustained focus on enhancing community resilience equitably across the nation.
The Federal Plan for ELTRR also strives to more completely define resilience leveraging the Vital Conditions for Health and Well-Being Framework. This inclusive framework is grounded in a set of vital conditions – such as clean air, fair pay, humane housing, early education, quality health care, and other basic necessities – that impact our ability to thrive. By identifying the intersections of all our collective efforts, making it clear where more deliberate investments are required, and applying a common lexicon within the Vital Conditions Framework, the Plan sets the stage for more meaningful cooperation across disparate sectors of government and society with the goal of an equitable future.
Complete details on the Federal Plan for ELTRR will be available on health.gov in the coming weeks. Stay tuned.
Attaining equity isn't an insurmountable task, so long as we coordinate our resources and efforts – not only as a public health community but as a whole of society – and resist the urge to silo them in the ineffectual ways of the past. This will allow us to move forward together and realize our shared vision of health equity as defined in Healthy People 2030: “the attainment of the highest level of health for all people.”
Yours in health,
Paul Reed, MD
Rear Admiral, U.S. Public Health Service
Deputy Assistant Secretary for Health
Director, Office of Disease Prevention and Health Promotion
In Officio Salutis